Commentary: Having meaningful conversations with seriously ill patients is about living

Live to treat, or treat to live?

When living with a serious illness, many people end up living their lives just to treat it—so much so that they sometimes forget to make time for the important things, like Create memories with your loved ones or completing items on a bucket list. Many seriously ill patients are unaware of the concept of time toxicity (time spent coordinating care, frequent trips to health facilities, seeking emergency treatment to relieve side effects, hospital stays, and follow-up tests).

However, patients with serious, life-threatening illnesses such as end-stage organ failure, severe frailty, or cancer, as well as their families and clinicians, must make difficult decisions. Decisions cannot be made based on clinical evidence alone. Decisions need to be made in a person-centred way regarding treatment and care recommendations.

That’s where Serious Illness Conversations (SICs) come in. These conversations are not limited to Deathbed Conversation.

These are candid conversations about the treatment or care options that best fit the patient’s priorities, concerns, and the various pros and cons that must be weighed when considering options. These conversations are about how to enable patients to live with realistic hopes and goals in the face of a life-threatening illness. Importantly, they provide patients with an opportunity to reflect on what is important to them so they don’t regret it.

It was during this conversation that our patient expressed his two wishes. After some discussion, he decided to fulfill his promise to his daughter without waiting for the treatment to take effect. With the help of volunteers and creative therapists, he and his family spent an unforgettable day at the Bird Park and created a work of art with his daughter, leaving a legacy for her.

He passed away a few months ago.

Admittedly, this patient had this conversation late in his or her illness. Ideally, such conversations should occur early in the course of illness and repeatedly as prognosis and priorities may change. They help guide current decisions and prepare the patient for future health care situations.